This map from the Centers for Medicare and Medicaid Services shows the number of marketplace insurers for each county as of Wednesday.

Centers for Medicare and Medicaid Services

The Affordable Care Act marketplace will be a mixed bag for Kansas consumers seeking health insurance for 2018.

Some will pay more for coverage, some less. And some will purchase new plans for which there is no price-point comparison.

In Missouri, insurers are proposing some hefty rate hikes.

The Kansas Insurance Department said the “range of average rate revisions” for individual and small-group plans on and off the ACA marketplace will be from 8.8 percent lower to 29 percent higher. That means that some consumers could see premium increases of more than 29 percent, but it’s impossible to say how many, said Julie Holmes, the department’s director of health and life insurance.

“It’s going to depend on who buys from which company,” Holmes said. “There are just so many variables.”

If there are substantial price spikes, many consumer who purchase Obamacare coverage may not be adversely affected. That is because the federal subsidies they receive to keep coverage affordable will also go up.

“So, they will be insulated,” Holmes said.

More than 80 percent of the Kansans who purchase coverage on the Obamacare marketplace qualify for some level of subsidy, according to the U.S. Department of Health and Human Services.

More consumer choice in Kansas

While the exit of some insurers from the ACA marketplace is limiting competition and choice in many states, most Kansans seeking coverage will be able to choose from 38 plans offered by three insurers.

“A lot of states are not in that favorable a position,” Holmes said.

Minnesota-based Medica will offer plans throughout the state in 2018, while Blue Cross and Blue Shield of Kansas will offer plans in all counties except Johnson and Wyandotte. Centene, a St. Louis-based company that specializes in Medicaid managed care, will offer plans in those two counties, following Blue Cross and Blue Shield of Kansas City’s decision in May to exit the Obamacare marketplace.

In several states — including the neighboring states of Nebraska, Oklahoma and Iowa — only one insurer is offering Obamacare plans, according to U.S. Department of Health and Human Services, the federal agency that oversees the marketplace. In Missouri, consumers in the Kansas City and St. Louis metropolitan areas have choices, but only one insurer is offering plans in most counties in the state.

Higher increases in Missouri

Rate proposals released Friday by the Missouri Department of Insurance are on average 36 percent to 42 percent higher than rates for similar 2017 plans.

“I’m not that surprised it’s that high, given the volatility that’s been going on with the Affordable Care Act,” said Timothy McBride, health economist at Washington University in St. Louis. “We’ve also seen some dropouts of some plans, which reduces the competition, which tends to increase the prices.”

Both Cigna and Anthem Blue Cross Blue Shield, the two companies returning to sell on the marketplace, listed the uncertainty about cost-sharing payments that help consumers cover the cost of insurance as justifications for their proposed rates.

Earlier this year 25 western Missouri counties had been left “bare” when Blue Cross and Blue Shield of Kansas City decided to exit the marketplace. In June, Centene Corp. stepped in to fill that void and offer plans in those counties.

“We’re new at this game, so we don’t know how well it’s going to work.” — Timothy McBride, health economist

This is the first year for Missouri consumers to have access to marketplace rate information before open enrollment and to provide feedback on proposed rates.

Unlike some states, Missouri’s Department of Insurance does not have the authority to deny an insurer’s request for a rate increase.

McBride said public input and rate review still could influence insurance rates.

“We’re new at this game, so we don’t know how well it’s going to work,” McBride said. “But it has helped in other states.”

Insurers may adjust rates before open enrollment, which begins Nov. 1 and continues through Dec. 15.

Obamacare politics persist

Kansas Lt. Gov. Jeff Colyer, a Republican preparing to step into the governor’s office when the U.S. Senate confirms Gov. Sam Brownback’s nomination to a State Department post, used the numbers released by the insurance department to intensify his criticism of Obamacare.

“The 29 percent increases for health insurance are another rung on the Obamacare ladder of failure, just months after this broken system forced a major insurer to leave the Kansas City market,” said Colyer, who also is running for the GOP gubernatorial nomination in 2018.

“I urge Congress to keep their promise to repeal Obamacare and allow us to work with our stakeholders to create Kansas solutions for Kansas families,” Colyer said.

Colyer’s statement is based on false assumptions, said Sheldon Weisgrau, director of the Health Reform Resource Project, an initiative funded by several regional health foundations that support the ACA.

“The lieutenant governor’s implication that the ACA marketplace plans will increase in price by 29 percent is false,” Weisgrau said, noting that the insurance department said that rate revisions would vary widely.

Rather than continue to “spread misinformation about the ACA,” Weisgrau said Colyer should encourage Congress to fix problems that are destabilizing the Obamacare marketplace.

“He (Colyer) should also insist that the Trump administration join these efforts and stop working to undermine the marketplace,” Weisgrau said, referring to the president’s repeated threats to halt payments to insurance companies intended to help them cover the cost of lowering out-of-pocket costs for consumers.

Uncertainty about the administration’s commitment to maintaining those cost-sharing payments has destabilized the marketplace and prompted companies to either withdraw or raise rates, Holmes said.

“It definitely has contributed to instability,” Holmes said. “The carriers are holding their breath waiting to see if the administration is going to authorize those payments.”

A U.S. Senate committee is set to begin hearings next week on a potential bipartisan plan to stabilize the Obamacare marketplace.

Jim McLean is managing director of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics. You can reach him on Twitter @jmcleanks. Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR.

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